Medical student attitudes toward psychiatry in relation to psychiatric career choice.
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Attitude↗
Biomedical subjects
J Yager
Publications and source records attributed to J Yager.
Screening of depression in relationship to subsequent patient and physician behavior.
When internal medicine clinic patients were prescreened for depression and this information was fed back to their physicians, significant effects could be noted on the medical records. On the initial visit, prescreening and previsit feedback about depression increased its notation in the medical record by three times, and among depressed patients, resulted in significantly fewer laboratory tests being orders (X = 2.85 vs. 8.12 for depressed patients with feedback after). During the following year, record notations about depression were more likely to be made for those depressed patients that initially were in the "feedback before" group. These patients also saw twice as many providers, made three times as many visits, had three times as any tests ordered, and twice as many medications prescribed as those depressed patients in the "feedback after" group. These findings demonstrate that simple prescreening and feedback techniques may have significant and persistent influences on several dimensions of patient and physician behavior.
Attitude of Health Personnel↗
Family issues in the pathogenesis of anorexia nervosa.
Factors residing in family systems have been implicated in the pathogenesis of anorexia nervosa. In this paper I critically review literature that bears on this issue: the transmission of anorexia nervosa in families; family stress patterns, personality and psychopathological characteristics of parents, parent-child interactions, and whole family systems. Much additional research is needed to accurately determine the precise nature of such factors and the extent to which they actually contribute to the appearance of this syndrome.
Achievement↗
Assessing assessment: the content and quality of the psychiatry in-training examination.
The authors rated questions on the 1979 Psychiatry Resident In-Training Examination for the knowledge area assessed and for quality. The number of questions devoted to each of 35 knowledge areas varied widely, ranging from zero to 52. Thirty-one percent of the 300 questions were judged to be weak. Satisfactory questions and weak questions were not randomly distributed among knowledge areas. Areas such as psychopharmacology and neurology lend themselves to many satisfactory multiple-choice questions, while a substantial number of knowledge areas do not. Psychiatric examinations that employ multiple-choice questions should concentrate only on those areas which can be adequately assessed by this method.
Curriculum↗
Medical students' evaluation of psychiatry: a cross-country comparison.
The authors reviewed studies of attitudes toward psychiatry held by 368 medical students at the University of California, Los Angeles (UCLA), and 204 senior medical students from two schools in Washington, D.C. They found that the attitudes of all these students were remarkably similar: they viewed psychiatry as a worthwhile medical specialty but one of low prestige and low precision and thought that most psychiatric patients could be adequately managed by non-physicians. On the basis of their findings the authors offer recommendations for teaching basic psychiatric skills and for improving psychiatry's image and attractiveness.
Attitude↗
Quality of life events in relation to psychiatric symptoms.
This prospective study explored the relationship of life changes to psychiatric symptom changes in psychiatric outpatients (N = 196) and a comparison group of nonpatients (N = 194). Subjects completed the Schedule of Recent Experiences and a symptom checklist bimonthly for 18 months. At all reporting intervals, symptoms and events were strongly correlated. Undesirable and uncontrollable events related positively and desirable events negatively to symptoms. Among symptoms, those of a dysphoric and somatic nature were most strongly associated with event change. Psychiatric patients also reported more undesirable, more uncontrollable, and fewer desirable events than the comparison group. We conclude that the relationship of life events to symptoms depends on the specific qualities of both events and symptoms. Undesirable and uncontrollable events appear to have a direct, and desirable events an inverse, association with dysphoric and somatic symptoms.
Adult↗
Life event reports by psychiatric patients, nonpatients, and their partners.
The Schedule of Recent Experience (SRE) was completed for three separate two-month periods by groups of male psychiatric patients, male nonpatients, and their partners (primarily spouses). Each partner completed the SRE for life events believed to have occurred to the index person. For both patient and nonpatient pairs, perfect agreement was reported for only about one third of the responses where at least one pair member reported an occurrence. With disagreements, index persons were little more likely than their partners to report that an event occurred. Agreement was higher for clearly worded than for vaguely worded items in both patient and nonpatient groups. Among nonpatient pairs only, agreement was higher for events that would be difficult to hide from a partner than for those that could be kept hidden. Agreement for undesirable events for either group.
Female↗
Physician-patient agreement about depression: notation in medical records.
Medical patients were prescreened for depression; their physicians were given the results of the screening to see if such intervention altered the frequency of the physicians' appropriate notations about depression in the medical record. As part of this study, physicians' and patients' global ratings of patient depression were examined in relation to Zung Self Rating Depression Scales (SDS) Scores and medical record notation. On their initial encounter in a University General Internal Medicine Clinic, physicians and patients were in close agreement about the extent to which patients felt sad or blue, and these global ratings correlated significantly with patients' self-reports on the SDS. In general, physicians tended to rate patients as more depressed than patients rated themselves. However, although medical record notations about depression were highly correlated with patient and physician global ratings of mood and with SDS scores, notations about depression appeared in only about 70% of charts where the physician assessed the patient's mood as being significantly depressed.
California↗
Testing psychiatric knowledge with in-house examinations.
Formal assessment during psychiatric training is becoming more common, not only to evaluate trainees but also to meet demands for educational and fiscal accountability. National norm-referenced tests such as the new psychiatry in-training examination may not meet the needs of many residency programs. The authors describe an alternate approach: an in-house test of psychiatric knowledge. The importance of educational objectives, test specifications, piloting the test, and item analyses is emphasized. The process is time-consuming, and the authors examine the advantages of this approach in terms of its costs.
Educational Measurement↗
Assessment of psychotherapy skills: the problem of interrater agreement.
Thirteen experienced supervising psychiatrists independently rated the psychotherapy interviews of six residents, using a detailed assessment instrument. Although interrater agreement was significantly greater than would be expected by chance, the extent of agreement was uniformly low. Agreement was significantly poorer for judgments about technique skills than about communication skills and for second-year than for first-year residents. Other factors, such as the faculty rank and training of the rater, did not covary significantly with observed ratings. The findings suggest that rating methods which purport to assess psychotherapy skills should undergo careful methodological evaluation and testing before they are accepted as valid assessment techniques.
Clinical Competence↗
Anorexia nervosa.
The clinical and physiologic features of anorexia nervosa seem to be consequences of a complex interaction among psychologic abnormalities, endocrine disturbances, and malnutrition. Although a spectrum of psychologic disorders has been observed, distortion of body image, weight phobia, disordered perception of hunger and satiety, and a sense of ineffectiveness are encountered most frequently. The impaired secretion of luteinizing hormone-releasing factor, release of gonadotropins, and production of estrogens reflect a defect in the hypothalamic-anterior pituitary-gonadal axis. Because most of the endocrine abnormalities are reversible with improved nutrition, they are probably secondary to malnutrition rather than to hypothalamic dysfunction. Hypercarotenemia observed in 16 of 21 patients studied recently seems useful in differentiating anorexia nervosa from other forms of malnutrition and weight loss. A combined medical and psychiatric approach has been successful in drastically reducing the mortality of this disorder.
Adolescent↗
Catatonia in the presence of mid-brain and brainstem abnormalities.
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Adult↗
A behavioral medicine course for postgraduate trainees in internal medicine.
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Behavioral Sciences↗
The effect of screening, sensitization, and feedback on notation of depression.
Medical records of 150 medical ambulatory care patients randomly assigned to groups in which screening for depression, physician sensitization about depression, and informational feedback to physicians were systemically varied were reviewed for physician notations about depression and its treatment. Forty-two percent of the 100 patients screened with the Zung self-rating depression scale had scores outside the normal range. Chart notation about depression was effectively and appropriately increased by feedback and sensitization from 8 to 25 percent, but these procedures were less effective in increasing treatment interventions, which were noted for 12 percent of the entire sample. Physicians responded to patient information about depression presented to them in the format of a laboratory test, and such previsit screening devices may increase physician attention to psychological problems in general medical settings.
Depression↗
Research training in psychiatry: a survey of current practices.
The authors surveyed current opportunities and research training practices in psychiatric residency programs. Although most programs offer at least a journal club and manb state that research experiences are available, very limited research resources are available to residents in many programs. The availability of research teaching is quite variable, and few programs budget or spend money for resident research. Further, very few programs require any direct reesarch experience. These findings offer a partial explanation for the shortage of research psychiatrists.
Curriculum↗
Sleep disorder over time: psychiatric correlates among males.
This 18 month prospective study assessed the time course of sleep disturbances in 85 male psychiatric out-patients and 103 male non-patients. Over one-third of the patients and 5 per cent of the non-patients reported frequent symptoms of insomnia during at least 14 of the 18 months. Frequency and chronicity of insomnia were strongly associated with intensity of psychiatric symptomatology, but not with diagnosis. Minor tranquillizers and hypnotics were used frequently by patients and occasionally by non-patients, but there was little indication that they altered the course of insomnia.
Adult↗
The fear of object loss, responsiveness to subliminal stimuli, and schizophrenic psychopathology.
Thirty schizophrenic patients were seen individually for three sessions in a balanced design. In each session, following subliminal stimulation with a neutral stimulus, a baseline assessment of pathology was made. Then, in different sessions, in counterbalanced order, each patient received one of three experimental (or "critical") stimuli: a) a neutral control stimulus; b) a message--CANNIBAL EATS PERSON--intended to activate aggressive ideation; c) a message--I AM LOSING MOMMY--intended to activate fantasies of object loss. Each of these conditions was followed by an initial and later assessment of pathology, and finally by a measure of the patients' sense of differentiation from a mothering figure. In the final session other measures were also obtained, including each patient's conscious association to the critical stimuli when presented supraliminally. The major results were: a) as in previous experiments, the subliminal aggressive message intensified pathology and aggressive ideation--especially for relatively undifferentiated and relatively nondefended patients; b) subliminal stimulation of fantasies of object loss also increased pathology--especially for nondefended patients--and also increased the patients' sense of merging with the mothering object; c) the patients' response to subliminal stimuli--including presumably neutral ones--was a function of the conscious meaning(s) of such stimuli. It was concluded that: a) the threat of object loss (real or fantasied) may be one of the motivations supporting the development of pathology in schizophrenics; b) the activation of fantasies of aggressive destruction can exacerbate schizophrenic pathology--perhaps by activating fantasies of object loss; c) future research with subliminal stimulation should consider carefully the differential responsiveness of subjects to the content of particular messages.
Adult↗
Harvester exposure to Zolone (phosalone) residues in peach orchards.
This field study was undertaken to quantitate the exposures of peach pickers to pesticide residues. Five fields were harvested each for three days at decreasing post-application intervals. Aerosol and dermal exposure estimates indicated 98-99% of the workers' dose was dermal, predominantly to the hands and upper extremities. Estimates of dose correlated with measurements of foliar residues. Despite estimated dose rates of up to 14 mg/hr, the RBC cholinesterase in these workers may have been only slightly inhibited (circa 4%) when compared to an unexposed, control population. Comparisons of these results with earlier studies of parathion residues on citrus indicate a consistent pattern of worker exposure. However, a concern is raised over the efficacy of using existing foliar residue sampling methodologies for all other pesticides.
Adult↗